Debunking the Myth : Do Inhalers Weaken Your Lungs? | Exploring the Effects of Inhaler Use

The winter season poses various types of challenges to some people; especially those who are prone to suffering from respiratory infections and those having lung disease. The quality of the air also goes down in the winter season, as people burn coal, wood and paraffin for warmth and this causes pollution.⁽¹⁾ Other than this, the rate of infections also increases.⁽²⁾

Doctors will have lot of patients on their hand who come with complaints of shortness of breath and chest tightness. The quick relief to these issues is more often than not inhalers. This is a device via which medication can be given directly into the lungs. Thus the importance of inhalers in management of “obstructive” lung diseases, such as chronic obstructive pulmonary disease and asthma is great. With the increasing use of inhalers, there are also increasing reports that “inhalers can damage or weaken the lungs.” In this article, we will discuss how far this statement is true.

The relationship between inhaler use and lung damage is not clear and the reports are more about the effect of medications that is corticosteroids which are inhaled, on the lungs. The concern is that these medications suppress immune system and inflammation and thus can make a person more susceptible to various infections.

Inhalers are only a mechanism for delivering the medicines and are used to give various types of medications. An all inclusive statement, such as “inhalers can weaken the lungs” is the same as saying “creams can harm the skin;” or “eye drops can harm the eyes.”

There are two varieties of inhalers: dry-powder inhalers and metered-dose inhalers.

Dry powder inhalers usually consist of plastics containing a mixture of the stabilizing agent, which usually is lactose and active medication in powder form. The stabilizing agent should not only be safe to inhale, but should also prevent clumping of the medication, in order to deliver the medication evenly to the lungs. This agent should also be non-irritating and should have the ability to be broken down by the body or be moved away and expelled by the cells which line the airways.

Metered dose inhalers comprise of a metal canister consisting of medicine and the substance which carries the drug, i.e. the propellant.⁽³⁾ The safety of the standard propellant utilized in the modern inhalers is such that that even dosages 200 times and more of the expected human exposure is deemed non-toxic.⁽⁴⁾ Partly the reason for this is the majority of the inhaled propellant is again exhaled almost immediately.

Lactose was tested extensively on animals and studies have found no evidence that lactose can cause harmful effects to the lungs.⁽⁵⁾ There are other studies also, which researched if dry powder inhalers are more harmful than metered dose inhalers. A study done in Brazil revealed that there was no difference in efficacy of drug delivery or in any side effects.⁽⁶⁾ A Swedish study also showed that there was no harmful effect of the lactose on the airways.⁽⁷⁾

According to the research, if inhalers are safe, then what is harmful about them? That leaves only the medicine used in the inhaler. So, let’s talk about that and how safe it is for your lungs.

Corticosteroids are a type of steroid, which are used in treatment and management of asthma.⁽⁸⁾ These drugs are known to improve the quality of life along with decreasing the mortality risks and hospitalization rates.^{(9, 10)} All this is thanks to the ability of this medicine to control inflammation. There are side effects of steroids, but those of inhaled steroids are greatly lesser than oral steroids.

The narrowing of the airways occurring in chronic obstructive pulmonary disease is thought to be long lasting, which leaves the role of steroids not that clear.

However, the data shows that in 2012, around 55 studies showed that the use of inhaled corticosteroids for more than six months and did not substantially halt the slow, but steady deterioration of the lung function in COPD.⁽¹¹⁾ Even though the prognosis of the disease remained the same, there was mild decrease in the symptoms and a minor associated improvement in quality of life of the patient suffering from COPD.

Another review in 2014 showed that increased doses of inhaled corticosteroid were linked with a moderate increase in hospitalizations for pneumonia.⁽¹²⁾

This is only the finding which brings us closest to “do inhalers weaken the lungs?” It is important to understand that the inhaler as a device does not weaken the lungs but the drug used and its ability of suppressing inflammation and also immunity is what increases the risk of the patient having lung infections.

Another study in 2014 where it specifically looked into the association between inhaled corticosteroids in COPD and pneumonia. Depending on the inhaled steroid which was used, the hospitalizations with pneumonia increased by 8 to 12 additional admissions per 1,000 people treated in a year. However, the difference in mortality rates between the study groups was not major.

In case of asthma, research from UK has shown that highest dose of inhaled corticosteroids has led to two-fold increase in the risk of lower respiratory tract infection or pneumonia.⁽¹³⁾

In asthma as well as chronic obstructive pulmonary disease, the use of high-dose inhaled corticosteroids can cause a slight increase in number of hospitalizations for lung infections, which is due to the immunosuppressant effect this medicine has. However, the increases in hospitalizations are not that major in absolute terms.

When it comes to asthma, the benefits of corticosteroids, such as improved quality of life and other better outcomes, greatly favors using this medicine for treatment and management of this disease.⁽¹⁴⁾ In case of COPD, it is advisable to determine the use of corticosteroids on a patient to patient basis by the doctor.

Even though corticosteroids, like any other medicine, have side effects to it, but making statement like all inhalers can damage or weaken the lungs is baseless as well as harmful. In fact these medicines are more beneficial when it comes to saving the life of the patient and improving the overall quality of the life, as proven by many studies and research.

References: